Did fainting at 18 cause my ongoing heart issues?

Question

Hello doctor,

I experienced a fainting episode when I was 18. It started three years ago. I had sudden, intense stabbing abdominal pain before fainting. The loss of consciousness lasted more than one minute. Before fainting, I experienced blurred vision and muffled hearing. Upon waking,

I had confusion, incoherent speech like a drunk, loud crying, trembling legs, and a slow recovery with weakness and shaky feet. I initially refused help, then was comforted by friends. The episode occurred in the metro.

Ongoing symptoms since fainting include:

Balance issues, especially when moving vehicles such as buses and the metro.
Persistent fatigue and weakness.
Leg and foot circulation problems, including varicose veins, swelling by the end of the day, relieved by rest, numbness, and color changes such as pale or purple when my legs are elevated, along with foot heaviness and a heat sensation.
Pain and numbness in my legs, especially after elevation.

Cardiac-related symptoms include:

Intense, irregular heartbeat sensations triggered by mild physical activity, such as running 100 to 200 meters.
I feel my heart beating very hard, or like it might stop.
A sensation of hearing my heartbeat loudly.
Weakness or fragility in my feet immediately after stopping physical activity, accompanied by malaise.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

From your description, your first fainting episode at age 18 sounds like a syncope (a temporary loss of consciousness and muscle strength), or loss of consciousness, preceded by intense autonomic symptoms such as abdominal pain, blurred vision, and muffled hearing, and followed by a slow recovery with weakness and confusion. Because you had confusion and trouble speaking afterward, we would also want to rule out seizure-like events, especially if there were abnormal movements or prolonged altered awareness.

The ongoing symptoms, including balance issues when moving vehicles, fatigue, varicose veins (swollen, twisted, blue or purple veins, usually in the legs), leg swelling, color changes, and discomfort when elevating your legs, suggest circulatory dysregulation.

This could include conditions such as postural orthostatic tachycardia syndrome (a chronic autonomic nervous system disorder), chronic venous insufficiency (occurs when leg veins cannot efficiently return blood to the heart), or other forms of dysautonomia (a dysfunction of the autonomic nervous system (ANS) that causes improper regulation of involuntary body functions). The strong and irregular heartbeat with minimal exertion also suggests the need to evaluate your heart rhythm and blood pressure response to activity.

At this stage, I would recommend the following evaluations:

Cardiac evaluation, including ECG (electrocardiogram), echocardiogram, and possibly a Holter monitor or event recorder.
Autonomic testing, including a tilt table test to assess for postural orthostatic tachycardia syndrome or other orthostatic intolerance.
Neurological evaluation, including EEG (electroencephalogram) and possibly brain imaging, to rule out seizure activity, given your prolonged confusion.
Vascular assessment, including Doppler ultrasound of the legs to assess venous function.
Basic laboratory tests, including CBC (complete blood count), electrolytes, thyroid function, iron studies, vitamin B12, and fasting glucose.

Until the diagnosis is more precise, you should avoid dehydration, stand up slowly, wear compression stockings for leg symptoms, and avoid prolonged standing. Any chest pain, sustained palpitations, or sudden worsening of symptoms should prompt urgent review.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.